The obesity paradox, as previously blogged, suggests that for some groups of people, there may be a survival benefit to carrying some excess weight – for example, people with cardiovascular disease, heart failure, and older people as well. Simply put, if these people become ill, they may be more likely to survive because they carry a little extra energy to sustain them through the illness.
Just like our society in general, we are seeing an increase in overweight and obesity in people with type 1 diabetes. (Type 1 diabetes is an autoimmune condition where the pancreas stops making insulin; type 2 diabetes occurs when the body tissues are resistant to the effects of insulin (made worse by overweight/obesity) and the pancreas cannot produce enough insulin to meet these higher needs.) There is little data looking at overweight/obesity in type 1 diabetes and whether carrying excess weight may be good or bad for this group of people.
A recent study evaluated over 26,000 patients with type 1 diabetes in the Swedish National Diabetes Registry to answer this question. Over the time course of the data studied (1998 until 2012) the average BMI of these people increased a little, from an average BMI of 24.7 at the start of the study, to 25.7 at the end. Over a median follow up of 11 years, they found that men with a BMI >25 had a slightly higher risk of cardiovascular disease, heart failure, and death. There was no association between BMI and any of these outcomes in women; as the authors note, the rates of these outcomes were quite low (and for scientists in the audience, confidence intervals wide), and this may have made it more difficult to establish any association between BMI and risk in women.
BOTTOM LINE: This study suggests that carrying excess weight in type 1 diabetes is not protective, and that the obesity paradox does not apply to people with type 1 diabetes as a whole. Thus, it remains important for people with type 1 diabetes and their health care providers to continue to help to manage weight along with managing their diabetes.
Dr Sue Pedersen www.drsue.ca © 2019
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